Provider Demographics
NPI:1285188755
Name:STEWART, LINDSAY LA DELL (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:LA DELL
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:LA DELL
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2125 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1693
Mailing Address - Country:US
Mailing Address - Phone:541-957-8544
Mailing Address - Fax:
Practice Address - Street 1:2125 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1693
Practice Address - Country:US
Practice Address - Phone:541-957-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015437183500000X
IDP7520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist